2016 Section 5 Green Book

Reprinted by permission of Int Forum Allergy Rhinol. 2016; 6(2):156-161.

OR I G I NAL ART I CLE

Endoscopic endonasal orbital cavernous hemangioma resection: global experience in techniques and outcomes

Benjamin S. Bleier, MD 1 , Paolo Castelnuovo, MD 2 , Paolo Battaglia, MD 2 , Mario Turri-Zanoni, MD 2 , Iacopo Dallan, MD 2 , Ralph Metson, MD 1 , Ahmad R. Sedaghat, MD, PhD 1 , S. Tonya Stefko, MD 3 , Paul A. Gardner, MD 4 , Carl H. Snyderman, MD, MBA 3 , Joao Flavio Nogueira, MD 5 , Vijay R. Ramakrishnan, MD 6 , Luca Muscatello, MD 7 , Riccardo Lenzi, MD 7 and Suzanne Freitag, MD 1

Background: Endoscopic orbital surgery represents the next frontier in endonasal surgery. The current literature is largely composed of small, heterogeneous, case series with li le consensus regarding optimal techniques. The purpose of this study was to combine the experience of multiple in- ternational centers to create a composite of the global ex- perience on the endoscopic management of a single type of tumor, the orbital cavernous hemangioma (OCH). Methods: This was a retrospective study of techniques for endoscopic OCH resection from 6 centers on 3 continents. Only primary data from strictly endoscopic resection of OCHs were included. Responses were analyzed to quali- tatively identify points of both consensus and variability among the different groups. Results: Data for a total of 23 patients, 10 (43.5%) male and 13 (56.5%) female were collected. The majority of le- sions were intraconal (60.9%). The mean ± standard de- viation (SD) surgical time was 150.7 ± 75.0 minutes with a mean blood loss of 82.7 ± 49.6 mL. Binarial approaches (26.1%) were used exclusively in the se ing of intraconal le- sions, which were associated with a higher rate of incom- plete resection (31.3%), postoperative diplopia (25.0%),

and the need for reconstruction (37.5%) than extraconal le- sions. Orthotropia and symmetric orbital appearance were achieved in 60.9% and 78.3% of cases, respectively. Conclusion: Extraconal lesions were managed similarly; however, greater variability was evident for intraconal le- sions. These included the laterality and number of hands in the approach, methods of medial rectus retraction, and the need for reconstruction. The increased technical com- plexity and disparity of techniques in addressing intraconal OCHs suggests that continued research into the optimal management of this subclass of lesions is of significant pri- ority. C 2015 ARS-AAOA, LLC. Key Words: endoscopic; orbital; intraconal; orbital cavernous heman- gioma; outcomes How to Cite this Article: Bleier BS, Castelnuovo P, Ba aglia P, et al. Endoscopic en- donasal orbital cavernous hemangioma resection: global experience in techniques and outcomes. Int ForumAllergy Rhinol . 2016;6:156–161. E ndoscopic orbital surgery represents the next frontier in endonasal surgery. The feasibility of endoscopic management of periorbital pathology including orbital 1 and optic nerve decompression 2 were first reported over 25 years ago. Over the next decade the first descriptions of endonasal approaches within the intraconal space be- gan to appear in the literature. 3,4 In subsequent years however, only a limited number of case series from high- volume institutions have been published, which report on a variety of orbital pathologies. 5–10 During the same pe- riod, the widespread proliferation of endoscopic skull-base surgery has been mirrored by a body of literature that has

1 Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA; 2 Department of Biotechnology and Life Sciences, Division of Otorhinolaryngology, University of Insubria, Varese, Italy; 3 Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA; 4 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; 5 Division of Otolaryngology, Hospital Geral de Fortaleza, Forta Leza, Brazil; 6 Division of Otolaryngology, University of Colorado, Denver, CO; 7 Division of Otorhinolaryngology, General Hospital of Massa, Massa, Italy Correspondence to: Benjamin S. Bleier, MD, 243 Charles Street, Boston MA, 02114; e-mail: benjamin_bleier@meei.harvard.edu Potential conflict of interest: None provided. To be presented at the ARS Annual Meeting, on September 27, 2015, in Dallas, TX

Received: 7 July 2015; Revised: 28 July 2015; Accepted: 11 August 2015 DOI: 10.1002/alr.21645 View this article online at wileyonlinelibrary.com.

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